Organization
NICH'K BEAUTY RX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENISHA WALLACE (OWNER)
(407) 758-5885
Entity
Organization
Contact information
Practice address
4909 RALEIGH STREET #7, ORLANDO, FL 32811
(407) 758-5885
Mailing address
9300 CONROY WINDERMERE RD UNIT 3397, WINDERMERE, FL 34786-5158
(407) 758-5885
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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